INTERNAL MEDICINE
BEGINNING YOUR RESIDENCY
July 16, 2014
G. Fitzgerald-Codd
Academic Skills Coordinator
UCI, School of Medicine
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“Change Points” ?
Points during their medical education experience when
Medical Students and Residents must adapt:
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New study/learning strategies
New perspectives re: their Time Management and
Organizational Skills
New test-taking approaches and strategies
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What Do New Residents Encounter?
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New environment
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New culture
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New schedule
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New routine and rules
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Research on Transitioning from Medical
Student to New Resident
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Literature is replete with information on various
transition points, difficulties, tips to survive the
transition year
Following information taken from Yao & Wright
(Journal of General Internal Medicine 2001:
16:486-492)
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Why Resident’ Problems Arise
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Literature confirms 3 distinct causative areas :
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Insufficient use of time (44%)
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Insufficient knowledge (48%)
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Poor clinical judgment (44%)
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Demands of a Resident’s Schedule
Results in:
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New stressors and challenges
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Need to do more
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Need to read and study more
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Less time to accomplish it all
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Lack of Time
Results in:
 Less time for things that make you unique
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Personal neglect
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Inability to keep pace with studies
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Sleep deprivation
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Coping With Stress
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Physical and mental stressors in residency
training can contribute to a resident’s poor
performance (Firth-Cozen, Morrison, 1989)
These stressors can be further delineated under
3 areas: situational, personal, and professional
(Resident Services Committee, Association of Program Directors in
Internal Medicine, 1988)
STRESSORS

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Situational: starting a new job, moving to a new
environment, sleep deprivation.
Personal: family situations (e.g., marriage, parenting) or
financial issues (e.g., educational debts)
Professional: more complex situations, difficult patients,
and career planning issues. Residents have noted that
factors such as excessive workloads, chronic fatigue, and
frequent on-call responsibilities contribute to their lack of
psychological well-being (Butterfield, 1998).
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Cognitive Impairment
Kahn & Addison (1992) define cognitive impairment as
“a state in which the resident’s ability to care for self or
others, particularly patients,, is hampered because of
stress, emotional illness, or substance abuse.”
Small ( 1981) described 7 features of house-officer
stress syndrome; four occurring in most residents and
the remaining three being more suggestive of serious
impairment.
Four Dimensions of Stress
4 features of stress syndrome found occurring in most
Residents (Small, 1981):
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Episodic cognitive impairment (due primarily to sleep
deprivation)
Chronic anger
Pervasive cynicism
Family discord
Sleep Deprivation
Manifests in several ways:
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Poor judgments
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Poor organizational skills
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Poor time management skills
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Poor planning
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My Role

Academic Skills Coordinator
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Conduct assessments
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Consultation/conference
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Assist with organizational skills, test-taking
strategies and time management
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Main Reasons Residents are Referred
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In-Service Training Exam (ITE) performance
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Step 3 Board score failure
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Test-taking strategies
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Process When Referred
Resident sets up appointment/s for:
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Assessment battery
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Consultation/conference
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Possible Problematic Areas
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Test-taking strategies, organizational and
time-management concerns
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Sleep deprivation
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Knowledge gaps
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Time Management
Need to manage your time differently, effectively, and
efficiently.
Ask yourself 4 questions:
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How do you use your time?
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Have you devised a new study plan?
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Do you have a daily schedule?
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Do you keep a daily schedule?
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5 Categories of Problems Residents May Encounter
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Category 1: Medical Professionalism:
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Reynolds (1994) defines medical professionalism as:
“serving the interests of the patient above one’s own interest.
Professionalism aspires to altruism, accountability, excellence, duty,
service, honor, integrity, and respect for others” (Reynolds, 1994).
Yao & Wright (2001), further add: “While there is little evidence
about the best way to teach professionalism to residents with a
deficiency in this area, role modeling by faculty and resident
colleagues is believed to be important.”
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Category 2: Emotional Impairment
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“Emotional impairment, including depression
and post-traumatic stress disorder symptoms,
is not uncommon during residency” (Samkoff &
McDrmott, 1987; Klamen, Grossman, & Kopacz,
1995).
Situational, personal, and professional domains
of stressors may also overlap.
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Preventive Management
Some things you can do to maintain homeostasis as
you begin your residency:
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Set up a new schedule template
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Stick to your new schedule; tweak as needed
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Importance and necessity of sleep should not be underestimated
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Exercise
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Set aside some downtime
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Maintain Personal Wellness
Wellness is a state of psychological & physical well being:
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It helps you to maintain balance between your residency and life
It makes you a better person, doctor, partner, and friend to others
and self
It enhances your general happiness, work, relationships, hobbies, &
other interests
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Q&A
ANY QUESTIONS?
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Contact Information
gcodd@uci.edu
Phone: (949) 824-3415
Medical Education Bldg.
UCI, School of Medicine
Irvine, CA